Komiyama Keisuke, Hamai Satoshi, Ikebe Satoru, Yoshimoto Kensei, Higaki Hidehiko, Shiomoto Kyohei, Gondo Hirotaka, Hara Daisuke, Wang Yifeng, Nakashima Yasuharu
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Clin Biomech (Bristol). 2019 Aug;68:175-181. doi: 10.1016/j.clinbiomech.2019.05.035. Epub 2019 Jun 15.
Dynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed.
This study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement.
During stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position.
Stationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.
全髋关节置换术（THA）后静态骑行过程中的动态髋关节运动学尚不清楚。此外，尚未评估基于体内运动学的髋臼杯最佳位置的计算机模拟。
本研究纳入7例因症状性骨关节炎接受单侧初次THA的患者。使用平板X射线探测器，在静态骑行过程中获取连续的X线片。我们使用图像匹配技术分析了从曲柄顶部到底部位置的三维置换髋关节运动学，并量化了最小内衬与柄颈距离。进行体内运动学模拟分析，以检查针对假体撞击的患者特异性最佳髋臼杯放置。
在静态骑行过程中，骨盆平均后倾27.1°，无明显变化。髋关节在顶部和底部位置分别平均屈曲59.4°和19.3°。底部位置的最小内衬与颈距离平均为8.8毫米。在任何髋关节的任何位置均未观察到内衬与颈、骨与骨或骨与假体的撞击。髋臼杯放置的模拟分析表明，更大的髋臼杯前倾角、倾斜度以及使用加高内衬显著减小了后内衬与柄颈之间的最小距离。使用加高内衬且髋臼杯前倾角超过30°可能会在底部位置导致后内衬与颈的撞击。
THA后静态骑行不会导致髋关节过度活动范围或内衬与颈接触。髋臼杯放置和加高内衬的使用显著影响最小内衬与颈距离，在某些情况下模拟假体后方撞击。
